Medical errors, a leading cause of death in the U.S., claim at least 250,000 lives every year.
They impact patients of all stripes and conditions. They happen in doctors’ offices almost as much as in hospitals. No matter where or to whom they occur, research suggests, medical errors are most likely when doctors interpret information incorrectly.
This may seem surprising for 1 department in particular. In the emergency room, where medical errors vary in result from injury at birth to elder abuse, medical professionals are short on time to gather enough information in the first place. It would be fair to assume that inadequate information is the reason emergency care goes wrong.
But according to a new study, the problem is the same in the ER as in inpatient wards: information processing errors.
Researchers Determined to Explain Medical Error in the Emergency Room…
For the study, researchers looked at patients readmitted to emergency departments within 72 hours of their first visit, indicating that an error may have prompted them to return. The goal was to find out whether the care team did make a mistake, and if so, what type of mistake occurred.
Only 6 percent and 18 percent of cases were tied to inadequate knowledge and incomplete information, respectively. Premature (and incorrect) diagnosis and misjudging significant findings were tied to 13 percent of cases each. The most frequently identified types of error were failure to process information (45 percent) followed by failure to verify it (31 percent).
The research aligns with experts’ consensus. Doctors have the training and oftentimes the information; they just fail to use the tools available to them in the right way. These “cognitive” errors or biases, as the study calls them, are completely avoidable.
Yet this isn’t the first study to explore cognitive error, and we’re no closer to finding a solution.
Most Errors Remain a Mystery
In the past, researchers reasoned that the fast pace and frequent interruptions typical of ER environments (and the resulting likelihood that information would be incomplete or unreliable) were responsible for the department’s errors. One study found incomplete medical histories were most problematic, as the basis of 42 percent of ER malpractice claims. Another pinpointed “failure to carry out the intended treatment.”
The solutions are just as inconsistent as the research. Some (such as checklists) work better in certain contexts than others, while existing solutions for cognitive bias (like so-called cognitive forcing strategies) help clinicians make more deliberate decisions but don’t help with information processing.
Perhaps doctors feel they’ve made enough effort to combat medical errors; they’re reluctant to accept responsibility, after all. Perhaps it’s only because of inconsistent research that doctors haven’t come up with a better way to measure cognitive errors. But more likely, said Dr. Aubrey Milunsky, adjunct professor at Tufts University School of Medicine, “nobody has taken major steps to put a stop to this carnage.”
The Solution: Education
“Nothing has worked in the sense of making a difference to the mortality,” Mulinsky said in an interview with WBUR, in the entire 19 years since the Institute of Medicine raised the alarm about astronomical rates of medical error death. Yet to him, the answer is simple: test medical students on risk management.
“The effect of [a risk management] examination is to have people absolutely aware of how mistakes are made,” Milunsky explained. “It’s not only a question of how to not make the wrong diagnosis, but the kinds of steps that occur in trying to reach diagnoses.”
In other words, while no doctor can avoid an error they can’t predict, they can try to understand how errors occur and use that knowledge to help prevent them.
The important thing to remember is that “most errors are made by good doctors,” Mulinsky continued. “There are slips, lapses, fumbles, distraction, preoccupation, inattention, laziness, carelessness, thoughtlessness. I could harangue you from here to Christmas about the things that go wrong that could easily be avoided.”
So until doctor training improves, all patients can do is advocate for their own health and hold (bad and good) doctors accountable for their mistakes. No matter how small those mistakes seem. Mulinsky’s best advice: Next time you’re admitted to hospital, take a friend who can advocate for you.
